I don't know what to think

Go for it. Having an opportunity to monitor these things early is a huge advantage too many of us never had.

Steve,

I may be mistaken but what this sounds like is the possibility of a bone met that is surrounded by soft tissue.

If so, a CT scan (with or without contrast) is likely not going to resolve the issue.  For that I think you may need to ask if a nuclear bone scan or MRI is the more appropriate test.

Speaking of which, have you had a full body nuclear bone scan?

Then again, I may be completely off base here.

-N

Stevewmass said:

thanks

No I haven't had a full scan didn't think that is was necessary with such an small tumor and low stage and grade. But now it is a different story 

Thanks

Steve after reading your post makes me wonder if my docs are taking me too lightly for follow up.  I had robotic lap neph aug 2012 for 2.4 cm tumor and  it was stage 1 grade 2 with all good margins.  Had 1st 6 month scan in mar and NED.  Now my urologist at univeersity Hosp. is leaving and he has given me to a Physicians assistant  and already have appt made for a year for an ultrasound of kidneys.  i dont feel safe with this.  Should I wait a year or find another Doc.    Hope all turns out well for u and ur being followed closely.

Stevewmass said:

thanks

No I haven't had a full scan didn't think that is was necessary with such an small tumor and low stage and grade. But now it is a different story 

Thanks

Hi. Neil was not talking about a full body CT scan, but a full body "nuclear bone scan". It's a different kind of a test specifically looking for bone abnormalities. You would not have had one until they see something abnormal on a CT scan with regards to your bones. It's not an active scan like a CT where radiation is passed through your body. Instead, they inject a small amount of a radioactive tracer into your blood, and then a few hours later they use a special camera to detect where the tracer was taken up and where it wasn't taken up. By looking at this they can see abnormalities in the bone where you might have wasting away or other areas where you might have new growth.

When I had my CT they found I had a small spot on my right femur, so they did this scan to see if it appeared to be RCC.

It's not a perfect test. There can be false positives and false negatives. It turns out none of these imaging tests are perfect. In my case they could tell it was not RCC from the scan alone. My doctor said that if it was inconclusive they might have to biopsy it to know.

They can also do a PET scan, but I had heard that the nuclear bone scan is supposed to be superior to the PET scan for this purpose. At least that's what my RCC oncologist told me.

If all you had is an XRAY, you probably should have the CT next as they suggested. If it's on the bone, you might need the nuclear bone scan. Sometimes they can tell something just from how quickly something appeared and how fast it's changing. If you had nothing a few months ago, and now you have something, that might tell them it's likely cancerous.

Hope it turns out to be an anomaly.

Best wishes,

Todd

todd121 said:

Blood tests...

I'd also been told that in addition to the nuclear bone scan, that if there are mets on the bone, they can sometimes show up in some of the blood tests. I'm sorry that I can't tell you exactly which test is likely to be abnormal, but I was told that one or two of my blood tests that they do when they do a full blood workup would most likely be abnormal if I had a met on my femur. I was told this by one of my RCC oncologists.

Todd

Hi Todd,

Likely they were referring to using the level of calcium in the blood as a clue to possible bone mets.

In early February I had a bad cough and was given a chest Xray.

It came back normal. Last month I had a CT of the chest without contrast and it showed two 4mm nodules. I went over this with a Pulmonologist last week Basically nodules that small do not show up on a Chest x-ray. Additionalli the nodules were only 1/2 the size where there would be a concern for RCC metes.

When I see my Urologist in a few months I will bring both the XRAY and CT films and reports with me to see if he has any concern. In reading Steve's post the concern for RCC could be bacause of his history of RCC. At least that is what we hope it is and nothing more.

Icemantoo

NanoSecond said:

PET scans and RCC

Generally PET scans are not very useful with renal cancer because most RCC tumors and/or mets do not manifest a high level of "the Warburg Effect".

The Warburg Effect is the key to how a PET scan works to reveal a tumor in the body. In a PET scan a radioactive medicine is first tagged to a natural chemical - usually glucose, water, or ammonia. This tagged natural chemical is known as a radiotracer. This radiotracer is then inserted into the body.

 

Inside the body the radiotracer then goes to those areas that normally utilize that natural chemical. For example, FDG (F-18 Fluorodeoxyglucose - a radioactive drug) is first tagged to glucose to make it into a radiotracer. The glucose then goes to those parts of the body that use glucose primarily for energy. The FDG can reveal a tumor by revealing those areas that are soaking up abnormally high levels of glucose. Most tumors soak up high levels of glucose because aerobic glycolysis (see below) is a very inefficient source of energy as compared to oxidative phosphorylation (i.e. “normal” respiration of oxygen).

Dr. Warburg found that if you took any “healthy” cell and slowly deprived it of its normal level of oxygen, at a certain point - around 30 to 35% of normal - the cell would do one of two things.  It would either die - or it would turn cancerous.  That is, in its struggle to stay alive it would "flip" from its normal mode of getting its energy from respiration (the "slow" burning of oxygen) – via a process called oxidative phosphorylation - to primarily getting its source of energy from the fermentation of glucose – via a process called aerobic glycolysis. He also discovered that once a cell had "flipped” its metabolism in this manner it could never be flipped back. There was no possibility of a tumor cell returning back to its "normal" oxygen-based respiration and so there was no possibility of a cancerous cell ever being restored to health again.

Thanks Neil. I think I got confused a bit between the two techniques. The bone scan doesn't use a radioactive tracer, but does use a radioactive substance and uses a camera to view the relative uptake of the radioactive substance? The PET scan uses the tracer as you described. This explanation really helped.

I had come across a paper at some point that discussed the reliability of these tests. They are suprisingly unreliable. One thing I seem to remember from reading the paper, was that things the bone scan misses tend to be things the PET would catch and vise versa. However, doctors rarely prescribe both tests from what I've noticed, even thought that would seem to give the best results. I suppose that's because of cost considerations?

As I recall, the PET scan is better at viewing tumors that are destructive to the bone (lytic lesions?), whereas the bone scan is better at picking up sclerotic lesions.

But I thought I had read somewhere that 60% of RCC bone mets are lytic? Because RCC is so agressive. I did read somewhere that some percentage of RCC mets are lytic and some other percentage (not a small percentage) are sclerotic, and that is what becomes difficult telling from imaging if something is RCC (or even cancer) and a biopsy might be required. On the other hand, my oncologist at City of Hope told me that their radiologists see so much cancer that they get pretty good at looking at it and telling when it is and when it isn't cancer. It implied to me that radiologists at non-cancer centers may not be so good at telling what they are looking at (even though I'm pretty sure they still see the anomalies and report them accurately).

I read all these papers, and then a month later I've gotten myself all confused. I'm sure lucky I'm not treating myself.

The imaging paper was very interesting, though. I'll see if I can find it again and post a link. It was an article talking about the challenges of using imaging to diagnose RCC (as I recall) and had looked into failure rates of different types of diagnoses based on imaging. It also went into the difficulties of measuring tumor load in evaluating whether drugs were being effective or not in treatment.

Todd

NanoSecond said:

Full Body Nuclear Bone Scan

Hi Todd,

I think it is accurate to say that both the PET scan and the full body nuclear bone scan just use different kinds of radiotracers in order to work.  This is not an area I have done much research in, but WIKIPEDIA gives a good introduction to the topic.  The entry also explains the relative advantages and disadvantages of each kind of imaging system:

http://en.wikipedia.org/wiki/Bone_scintigraphy

Although my bone mets were revealed by a full body nuclear bone scan (and they were all seen to be lytic lesions), I also consult with a bone cancer specialist who insists on taking good 'ole X-Rays of only those areas where I have mets.  The full body scan revealed "activity" where there were lesions but the X-Rays showed whether or not that activity was due to tumors expanding or to new bone growth.  So far (knock wood) it has been only the latter for me.

Hi Neil,

That's something my uncle said when I was getting the bone scan done. He said if it were him, he'd probably just get an X-ray to start with and have a look. He said sometimes you can tell quite a bit from just a good'ole X-ray.

Todd